POS1517-HPR PATIENT AND CLINICIAN PERSPECTIVES ON IMPLEMENTING THE RADAI-F5 TOOL TO HELP INFORM THE ASSESSMENT AND MANAGEMENT OF FOOT DISEASE IN RA: A QUALITATIVE STUDY
Authors: A. Hoque, D. Dickson, M. Steultjens, G. Hendry
Journal: Annals of the Rheumatic Diseases (2022)

Background While patient-reported outcome measures (PROMs) are widely recommended in clinical care, their application is limited [1]. The RADAI-F5 is a validated PROM to determine RA foot disease activity [2]. Patients’ and clinicians’ perceptions of the RADAI-F5’s clinical utility have yet to be captured. Objectives This study aims to explore patient and clinician opinions and perceptions of the clinical utility of the RADAI- F5’s in managing rheumatoid foot disease. Methods A 60-minute semi-structured interview using video conference calls with adult RA patients and rheumatologists, physiotherapists, and podiatrists was conducted as part of the interpretive phenomenological analysis research. The interviews included open-ended questions about the effect of foot disease, current clinical utilization of PROMS, and barriers and facilitators to the clinical application of the RADAI-F5. Inductive thematic data analysis with Nvivo12 identified emerging themes. Results Eight participants with rheumatoid arthritis: seven females; mean [standard deviation, SD] age 52.4 [9.5] years; mean [SD] disease duration 16.1 [16.4] years; eight clinicians; mean [SD] age 46.75 [5.3] years; mean [SD] years of clinical experience 19.5 [2.21] years. Four main themes were identified (Table 1); ‘Feet are a priority’ as the impact of RA on the feet was substantial and had a negative impact on quality of life. The second theme was ‘Need for a clinically feasible foot PROM’ as clinicians and patients recognised the lack of a clinically feasible tool that can determine RA foot disease. The third emerging theme was ‘RADAI-F5 facilitators’ as the tool can promote communication, guide management, help screen foot symptoms, monitor foot disease status and treatments longitudinally, and promote patient education. The final theme was ‘RADAI-F5 barriers’ as there were associated practical difficulties, including lack of appointment time, administrative burdens associated with PROM use, lack of trust in the RADAI-F5’s validity and IT barriers since there is no universal electronic system for reporting RADAI-F5 results. Table 1. Themes with respective quotes that emerged as part of the individual interviews to understand the clinical utility of the RADAI-F5 Theme Quotations Theme 1 : Feet are important “Foot disease is common and it’s troublesome for patients” (C16 ) “I couldn’t see my friends because I was always so tired and in pain. It is very lonely.” (P07 ) Theme 2 : Existing methods for measuring foot disease activity are inadequate “The feet are under-represented in the clinical tools for assessing disease activity, and clinicians don’t look at feet enough.” (C11 ) “We’ve tried numerous PROMS. Historically, I think probably it’s time-consuming for our clinical consultation”. (C12 ) Theme 3 : RADAI-F5 facilitators “I think [The RADAI-F5] improves the clinician-patient relationship” (C15 ) “Using the RADAI-F5 could measure the success of the treatments that we are implicating.” (C12 ) Theme 4 : RADAI-F5 barriers “I mean, this (RADAI-F5) will obviously go along with other tools. You know, the blood tests and things as well.” (P01 ) Conclusion The RADAI-F5 has significant potential as a therapeutic tool to aid in managing foot disease in RA. However, several implementation barriers need to be overcome before widespread use in rheumatology clinics can occur. References [1]Muradin I, van der Heide HJ. The foot function index is more sensitive to change than the Leeds Foot Impact Scale for evaluating rheumatoid arthritis patients after forefoot or hindfoot reconstruction. International orthopaedics . 2016; 40: pp.745-9. [2]Hoque A, Gallagher K, McEntegart A, Porter D, Steultjens M, Woodburn J, Hendry GJ. Measuring Inflammatory Foot Disease in Rheumatoid Arthritis: Development and Validation of the Rheumatoid Arthritis Foot Disease Activity Index–5. Arthritis Care &amp; Research. 2021;73: pp.1290-9. Acknowledgements Gordon Hendry, Diane Dickson and Martijn Steultjens Disclosure of Interests None declared